| NPI | 1710011507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 2449) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP00417) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2021-06-08 |